Resting-State Functional Connectivity and Cognition After Major Cardiac Surgery in Older Adults without Preoperative Cognitive Impairment: Preliminary Findings.
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OBJECTIVES: To look for changes in intrinsic functional brain connectivity associated with postoperative changes in cognition, a common complication in seniors undergoing major surgery, using resting-state functional magnetic resonance imaging. DESIGN: Objective cognitive testing and functional brain imaging were prospectively performed at preoperative baseline and 6 weeks after surgery and at the same time intervals in nonsurgical controls. SETTING: Academic medical center. PARTICIPANTS: Older adults undergoing cardiac surgery (n = 12) and nonsurgical older adult controls with a history of coronary artery disease (n = 12); no participants had cognitive impairment at preoperative baseline (Mini-Mental State Examination score >27). MEASUREMENTS: Differences in resting-state functional connectivity (RSFC) and global cognitive change relationships were assessed using a voxel-wise intrinsic connectivity method, controlling for demographic factors and pre- and perioperative cerebral white matter disease volume. Analyses were corrected for multiple comparisons (false discovery rate P < .01). RESULTS: Global cognitive change after cardiac surgery was significantly associated with intrinsic RSFC changes in regions of the posterior cingulate cortex and right superior frontal gyrus-anatomical and functional locations of the brain's default mode network (DMN). No statistically significant relationships were found between global cognitive change and RSFC change in nonsurgical controls. CONCLUSION: Clinicians have long known that some older adults develop postoperative cognitive dysfunction (POCD) after anesthesia and surgery, yet the neurobiological correlates of POCD are not well defined. The current results suggest that altered RSFC in specific DMN regions is positively correlated with global cognitive change 6 weeks after cardiac surgery, suggesting that DMN activity and connectivity could be important diagnostic markers of POCD or intervention targets for potential POCD treatment efforts.
Published Version (Please cite this version)10.1111/jgs.14534
Publication InfoAlexander, John Hunter Peel; Berger, Miles; Bisanar, Tiffany L; Browndyke, Jeffrey Nicholas; Gaca, Jeffrey G; Harshbarger, Todd Brenson; ... White, W (2017). Resting-State Functional Connectivity and Cognition After Major Cardiac Surgery in Older Adults without Preoperative Cognitive Impairment: Preliminary Findings. J Am Geriatr Soc, 65(1). pp. e6-e12. 10.1111/jgs.14534. Retrieved from http://hdl.handle.net/10161/13329.
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Professor of Medicine
John H. Alexander, MD, MHS is a cardiologist and Professor of Medicine in the Department of Medicine, Division of Cardiology at Duke University School of Medicine, as well as the Vice Chief, Clinical Research in the Division of Cardiology. He is the Director of Cardiovascular Research at the Duke Clinical Research Institute where he oversees a large group of clinical research faculty and a broad portfolio of cardiovascular clinical trials and observational clinical research programs. He is a
Assistant Professor of Anesthesiology
My research team focuses on understanding the cause of postoperative cognitive dysfunction (POCD) and delirium, and whether these disorders are caused by perioperative changes in Alzheimer's disease pathways. We are also interested in whether delirium or POCD are associated with an increased long term risk of developing Alzheimer's disease. Towards these ends, we use a combination of methods including cognitive testing, CSF and blood sampling, functional neuroimaging, and rigorous biochemical as
Associate Professor in Psychiatry and Behavioral Sciences
Dr. Browndyke is an Associate Professor of Geriatric Behavioral Health in the Department of Psychiatry & Behavioral Sciences. He also holds affiliate faculty appointments with the Duke Brain Imaging & Analysis Center (BIAC), Duke Institute for Brain Science (DIBS), Center for Cognitive Neuroscience (CCN), and the Duke Center for Geriatric Surgery. He has dual appointment to the Duke University Medical Center and the Durham VA Medical Center, the latter of which is where his c
Associate Professor of Surgery
Medical Center Instructor in the Center for Brain Imaging and Analysis
Jerry Reves, M.D. Professor of Cardiac Anesthesiology
Current research interests include:1. The relationship between white matter patency, functional connectivity (fMRI) and neurocognitive function following cardiac surgery.2. The relationship between global and regional cortical beta-amyloid deposition and postoperative cognitive decline.3. The effect of lidocaine infusion upon neurocognitive function following cardiac surgery.4. The association between genotype and outcome after cardiac surgery.5. Atrial fibrillation
Professor Emeritus of Anesthesiology
Best known for his work in assessing and improving clinical outcomes and quality of life following cardiac surgery, Dr. Mark Newman is President of the Duke Private Diagnostic Clinic (The Duke Faculty Practice Organization) and the Merel H. Harmel Professor of Anesthesiology at Duke University Medical Center. In addition, Dr. Newman developed the Multicenter Perioperative Outcomes Research Group of the Duke Clinical Research Institute established at Duke in 2001 to further the study of strategie
Associate Professor in Psychiatry and Behavioral Sciences
Dr. Smith is interested in the impact of lifestyle interventions, such as diet and exercise, on neurocognitive function and mood. He has also published multiple studies examining the relationship between cardiovascular disease, major depressive disorder, and neurocognitive outcomes, preoperative predictors of postoperative delirium, the impact of cardiothoracic interventions on neurocognitive outcomes, and the relationship between patterns of dietary intake and cardiovascular outcomes. He is als
Professor of Psychiatry and Behavioral Sciences
Dr. Kathleen Welsh-Bohmer is a Professor of Psychiatry with a secondary appointment in the Department of Neurology. She is also the Chief of the Medical Psychology CPU, the professional home for the over 200 academic psychologists within Duke Medical Center. Clinically trained as a neuropsychologist, Dr. Welsh-Bohmer's research activities have been focused around developing effective prevention and treatment strategies to delay the onset of
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